[HSF] Rt thoracotomy MVR

[Tea Acuff]

Let's not confuse the primary data (and its interpretation) with alternative perspectives from minority gestalts. Such views are unmeasurable and invalid...or is that not valid... Anyway just the facts.
tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Tuesday, March 11, 2008 5:47:19 PM
Subject: RE: [HSF] Rt thoracotomy MVR

> Why would a sternotomy improve her chances of a repair?> 
Because of better exposure, better instrumentation, better comfort and higher threshold to tolerate long ischemia times. I agree that all these are relative and experienced 'side-surgeons' can accomplish easily most of what can be done via sternotomy but that will certainly not be the case with Nand as her rarely employs such an approach. 

Also the reality is very different from the practice even if you look at expert series and side surgeons definitely replace the more difficult valves. For example, a critical study of the series from Mohr, Vanerman and Chitwood - all well versed in side surgery - would show a higher replacement rate (all more than 10%) that one would expect for such experienced valve surgeons.

Ani





> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Rt thoracotomy MVR> Date: Tue, 11 Mar 2008 16:26:47 -0400> From: dukeb60 at aol.com> CC: > > Why would a sternotomy improve her chances of a repair?> > > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Tue, 11 Mar 2008 1:09 pm> Subject: RE: [HSF] Rt thoracotomy MVR> > > > > I have a young lady who underwent pectus repair many years ago. She now> needs > mitral replacement for severe MR. I am planning to do it through a> right > thoracotomy.> > Nand> > Why exactly do you want to do this through a right thoracotomy? Certainly there > is no indication for a thoracotomy per se as the procedure will be easily > accomplished via sternotomy. If thoracotomy is not your usual approach for > mitral surgery, and if it is not the patient requesting a thoracotomy, then may > be best to stick to the approach you are used to in such an unusual case.> >
 Does the patient certainly need a replacement (and why?) - would a sternotomy > improve her chances of repair or is valve certainly irreparable?> > ANi> > > > > > Date: Mon, 10 Mar 2008 20:47:10 +1300> From: nkkejriwal at gmail.com> To: > OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Rt thoracotomy MVR> CC: > > > Hi> > I have a young lady who underwent pectus repair many years ago. She now> > needs mitral replacement for severe MR. I am planning to do it through a> right > thoracotomy. I have not done many of these. The last I did was a> gentleman with > mitral prosthesis endocarditis last year. In that case, I did> not release too > many adhesions and did it under fibrillatory arrest.> > In this lady I am hoping > to cross clamp the aorta. I know some of you have a> large experience with MVR > through Rt thoracotomy. Any tips?> > Nand> _______________________________________________> > OpenHeart-L mailing list> > Send postings to:>
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